Prescription

Re "Shotgun medicine," Opinion, March 28 Eric J. Topol makes the same error with regard to drug prices and costs that we caution our freshman economics students to avoid. The societal cost of another prescription is not its price but its marginal cost: the cost of producing and selling one more pill, which of course is vastly lower than the prices that are charged. What explains this difference is the means we use to finance the cost of developing and introducing the next generation of pharmaceuticals.

California Atty. Gen. Kamala D. Harris on Thursday called on Gov. Jerry Brown to restore funding to a prescription drug-monitoring program that health experts say is key to combating drug abuse and overdose deaths in the state. Harris' appeal to restore funding to CURES, as it is known, follows an article in The Times last month that reported that the system, once heralded as an invaluable tool, had been severely undermined by budget cuts and was not being used to its full potential.

An Orange County sheriff's deputy has been arrested on suspicion of trying to obtain medication with a forged prescription, Newport Beach police said Thursday. Gerald Edward Williams, 48, of Newport Beach was arrested Tuesday, Sgt. Evan Sailor said. Williams' work assignment was at Theo Lacy Branch Jail. He has been placed on administrative leave pending a personnel investigation by the department, spokesman Jim Amormino said.

The undercover sheriff's deputy pretending to be a patient in pain presented a Glendora physician with an X-ray to accompany her tale of an injured back and neck. The only problem was the X-ray revealed a "tail" of a different kind - one belonging to a dog. Though the X-ray for a German shepherd had the dog's name, Recon, and the name of an animal hospital printed on it, the doctor wrote the deputy a prescription for a powerful narcotic painkiller and a muscle relaxant, law enforcement officials said.

Retired social worker Nina Nestor got an all-too-familiar phone call last week: Her prescription refill was ready at her CVS store in San Clemente. Trouble is, the 83-year-old cancer patient didn't ask for the refill or numerous others that CVS pharmacists filled this year without her permission. "The pharmacist told me after two weeks they put it back in stock and reverse the billing," Nestor said. "But I wonder about that. " Government officials share her concerns. Allegations that the pharmacy giant has been automatically refilling medications without patient consent - and possibly overbilling insurers and government programs for unused medicine - have sparked four government investigations in recent weeks, the most recent by the U.S. Justice Department.

It's not too soon to start thinking about how to deal with your flexible spending accounts (FSAs) in 2011. How you can use the accounts ? which allow employees to set aside money from each paycheck, income-tax free, to be used for medical expenses ? is set to change in several key ways. Under the new healthcare reform law, people whose employers offer the accounts will no longer be able to use the funds for non-prescription drugs without a doctor's prescription. (Think antihistamines such as Benadryl or Claritin and their generic versions, or pain relievers such as Advil or Tylenol and generic versions.

For a generally progressive state, California falls surprisingly behind on certain issues. One of these is allowing the purchase of syringes without a prescription. Syringes are already an over-the-counter medical supply in 47 states. It's long past time for the same to be true in California. A pilot program signed into law in 2004 by Gov. Arnold Schwarzenegger allowed sales of syringes by pharmacies in counties that elected to join. Los Angeles was one of those. Yes, most of the sales were to addicts, who used the syringes to further their use of illegal drugs.

The request for drugs for Anna Nicole Smith slid off the fax of a Valley Village pharmacy five days after the model's son had died in the Bahamas. A psychiatrist wanted 300 tablets of methadone, two types of sedatives, a muscle relaxer, an anti-inflammatory drug and four bottles of a painkiller nicknamed "hospital heroin," unsealed court records show. The amount and combination alarmed the pharmacist, who later recalled thinking, "They are going to kill her with this." He phoned Smith's internist and said he had no intention of filling a prescription that amounted to "pharmaceutical suicide," according to court documents.

The instructions aren't on any box of medicine, but Mexicans know them all the same: At the first sign of sore throat or fever, race to the pharmacy for antibiotics. Take as you see fit. Even though the law requires a prescription for antibiotics, pharmacists in Mexico seldom ask for one before handing them over. And they hand them over by the boatload: nearly 2 billion doses of antibiotics a year, enough for two full courses of treatment for almost each of the nation's 110 million people.

Confusing directions on liquid suspensions of the antiviral drug Tamiflu may inadvertently cause parents to give either too little of the drug, impeding the child's recovery, or a toxic overdose, physicians warned in a letter published Wednesday in the online version of the New England Journal of Medicine. Prescriptions for the drug are often written with doses in fractions of a teaspoon, but the dropper packaged with the drug is marked in milligrams, requiring a difficult conversion of units, said the study's lead author, Dr. Ruth Parker of the Emory University School of Medicine.